Postoperative fever

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Postoperative fever is a common condition challenging doctors to find the right diagnosis, because it can be a hallmark of serious underlying conditions. One third of patients develop fever after surgery depending on type of surgery but only a small percentage turn out to be due to infection.[1]


The most common causes have been summarized in a handy mnemonic: the five Ws.[2] These tend to occur at specific days after surgery (postoperative days or POD).

Category Day Description
Wind POD1-2 the lungs, i.e. pneumonia, aspiration, and pulmonary embolism. Once attributed to atelectasis, but a recent review suggests that is not supported by existing clinical evidence.[3][4]
Water POD3-5 urinary tract infection, related to indwelling catheter (during surgery or currently i.e. Foley catheter )
Walking (or VEINS, which then sounds like "Weins") POD4-6 deep vein thrombosis or pulmonary embolism
Wound POD5-7 surgical site infection, which in obstetrics or gynaecology, may refer to the uterus.
Wonder drugs or “What did we do?” POD7+ drug fever, infections related to intravenous lines or reaction to blood products

Numerous variants on the same theme may exist: sometimes another W for "Wonder why" may indicate an abscess somewhere in the body or the site of surgery. Of course, this list is not comprehensive: catheter-related sepsis is also frequent, but also easily recognised. Other important, yet omitted, causes of early post-operative fever include malignant hyperthermia- a potentially life threatening but treatable response to halogenated anesthetics and paralytics, as well as a febrile non-hemolytic transfusion reaction and transfusion-related acute lung injury due to blood products which may have been given during or after the surgery, such as packed red blood cells, platelets or fresh frozen plasma.

Postoperative fever, especially when appearing in the first 24 hours after a major surgery, are most often a result of a natural and non-infectious inflammatory response to tissue injury sustained in the procedure itself, and often requires no medical intervention.[5][6]

Popular culture[edit]

In the pilot episode of the medical drama Grey's Anatomy, Meredith Grey refers to this mnemonic: "Wind, water, wound, walking, wonder drugs. The 5 Ws. Most of the time it’s wind; splinting or pneumonia. Pneumonia is easy to assume. Especially if you're too busy to do the tests." [7]

See also[edit]


  1. ^ Walid MS, Woodall MN, Nutter JP, Ajjan M, Robinson JS Jr (2009). "Causes and risk factors for postoperative fever in spine surgery patients". South Med J 102 (3): 283–286. doi:10.1097/SMJ.0b013e31819676a4. PMID 19204624. 
  2. ^ David Cline; Latha G. Stead (10 December 2007). Abdominal Emergencies. McGraw Hill Professional. pp. 146–. ISBN 978-0-07-146861-9. Retrieved 7 August 2010. 
  3. ^ Pile JC (2006). "Evaluating postoperative fever: a focused approach". Cleve Clin J Med 73 (Suppl_1): S62–6. doi:10.3949/ccjm.73.Suppl_1.S62. PMID 16570551. 
  4. ^ Mavros MN, Velmahos GC, Falagas ME (2011). "Atelectasis as a cause of postoperative fever: where is the clinical evidence?". Chest 140 (2): 418–24. doi:10.1378/chest.11-0127. PMID 21527508. 
  5. ^ Harrison G Weed, MS, MD, FACP; Larry M Baddour, MD, FIDSA. "Postoperative Fever". UpToDate. Retrieved 30 June 2011. 
  6. ^ Marino's The ICU Book
  7. ^'s_Anatomy/Grey's_Anatomy_1x01_-_A_Hard_Days_Night.pdf